Aug 28 2007
Mountain Biking and Foot Injuries
Mountain biking has inherent risks which are dependent on the type of trail and skill level of the rider. Many riders think of broken collarbones and separated shoulders as the main risk of mountain biking, but don’t realize the impact on the foot and ankle during cycling. Blunt trauma from rocks, roots and trees is certainly a risk, and only trail choice matching the rider’s skill level can minimize or prevent these injuries. Lesser known and more chronic lower extremity problems associated with cycling include Achilles tendonitis, ball of foot pain, numbness in the toes, knee and ankle pain.
Most of these problems are a result of improper bicycle fit, improper shoes, improper training and faulty foot mechanics. Despite the low impact nature of cycling, the mechanics of the foot can still have a tremendous impact on foot, ankle and knee injuries.
- Knee pain (inside): For those individuals who overpronate, the excess rotation places stress at the inside of the ankle and the inside of the knee, especially when climbing. (More on pronation). An orthotic can help control overpronation and limit abnormal stresses in these areas, helping to prevent chronic injury. Placing a sport orthotic in a cycling shoe can be a challenge because cycling shoes generally have a narrow design and little depth. It will pay off to find a cycling shoe with a thicker removable insole, with more depth, that will allow enough room for an insert or orthotic if you have encountered these problems. A visit to a podiatrist for evaluation of your foot mechanics may help, as sometimes a simple wedge placed in the shoe can solve the problem. Clipless pedals may also contribute to this problem, as they tend to hold the foot in a rigid position. Loosening the pedals may help, or switching to a clipless pedal system which allows for angular motion and lateral float (Time pedals are a good example).
- Knee pain (back of knee): Pain at the back of the knee is generally associated with the seat being too high. The pain is generally encountered while climbing. Lower the seat can give immediate relief.
- Knee pain (front of knee): Pain at the front of the knee (generally just under the knee cap, called the patella) is associated with the seat being too low. The pain is generally encountered when climbing, but many lower their seat posts for descents and then don’t raise the seat for the remainder of the ride. Over time this can contribute to knee pain.
- Shin splint pain: Although more common in runners, cyclists can experience shin splint pain as well. Shin splint pain is due to an imbalance between the muscle groups and is more common when climbing steep hills and in those with overpronation. Orthotics, the right pair of cycling shoes and stretching will help treat and prevent this problem. More on shin splints.
- Ankle pain: Pain at the inside of the ankle may be due to excess stress at the ankle or due to a tendonitis. Both problems are generally causes by overpronation and can be resolved with an orthotic in the cycling shoe or even a simple wedge as mentioned above.
- Ankle sprain: Ankle sprains are more common for mountain bikers than road cyclists. Clipping out of the pedals and stepping down on uneven terrain can cause an ankle sprain or even an ankle fracture. Many downhillers spend a lot of time hiking their bike up the hill over uneven, rocky terrain to huck their bike off of a rock or log or just to descend. This simple activity can result in a twist of the ankle. More on ankle sprains.
- Heel pain: Pain in the back of the heel is generally due to Achilles tendonitis. Achilles tendonitis is common in cyclists who do a lot of climbing and seen more often in road cyclists. To help treat and prevent this problem, avoid dropping the heel while climbing and make sure you have a rigid cycling shoes, as this will allow for a better lever arm for propulsion. Consider an evaluation by a podiatrist to see if you have overpronation, because a wedge or insert may help. During the treatment period for Achilles tendonitis, avoid climbing hills, stick to the flats and avoid sprinting. More on Achilles tendonitis.
- Ball of foot pain: Pain under the ball of the foot is common in cyclists because of the amount of force on the ball of the foot from pressure through the pedal and the tight, narrow nature of the cycling shoes. Metatarsalgia is the descriptive term for general pain in the ball of the foot, but the causes include capsulitis, 2nd metatarsal overload, neuromas and sesamoiditis.
Many times it is due to improper shoe fit. A shoe which is too narrow can reduce circulation and cause nerve compression, resulting in a numb feeling in the ball of the foot or a dull achy pain. Pressure on a nerve in the bottom of the foot can send electrical pain, tingling and numbness to the 2nd, 3rd and/or 4th toes from a neuroma. More on ball of foot pain.
- Top of foot pain: Pain and/or numbness on the top of the foot is generally due to compression on a nerve from shoes being strapped down too tight. This is common in more competitive cyclists who want the most efficient pedal stroke. Simply loosening the shoe, purchasing a better fitting shoe, or using padding to decrease pressure on the top of the foot will solve the problem. Those with high arch feet are more likely to encounter this.
- Leg and foot pain: Numbness, tingling and pain in the foot and leg, especially when accompanied by some limitation of movement, could be a compartment syndrome and although an acute (and chronic) compartment syndrome is rare in cyclists, it should be taken seriously and should receive immediate medical attention. Numbness, tingling and dull pain with some loss of function which is relieved by rest and aggravated by activity could be a chronic compartment syndrome and seeking medical attention by a sports medical professional is advised.
The breaks, sprains and bruises are the obvious injuries for mountain bikers, but not the only injuries. Appropriate shoe fit, training methods and orthotics (if necessary) will help prevent many of the chronic cycling injuries.
